The aims are to investigate the gastric physiology of the gastric pathogen Helicobacter pylori. Specific Aims: (A). Identify the acid response regulon and signaling system of the cytoplasmic pH sensor. HP0244 is a previously unsuspected sensor of cytoplasmic pH. Using transcriptome analysis after pH 2.5 incubation, the HP0244, HP0703 independent, regulon will be identified to separate periplasmic (HP0165) from cytoplasmic pH) regulation and confirmed by qPCR;(B) Identify colonization dependent gene expression and evaluate pH control of their expression by comparative transcriptome analysis of H. pylori from infected gerbils with and without acid suppression. Transcriptome analysis of H. pylori infecting the gerbil stomach compared to in vitro cultured H. pylori showed a greater up-regulation of genes encoding proteins involved in acid acclimation than at pH 4.5 in vitro, likely reflecting a pH <4.5 in the niche of the colonizing organisms. Cell division, wall and protein biosynthesis genes were also increased. Preliminary data show that acid inhibition by a PPI reduces expression of the former group to the level found at pH 4.5 in vitro but augments expression of the latter three groups of growth-related genes, this may explain the need for a combination of a PPI with growth-dependent antibiotics for triple therapy. These data may lead to dual therapy with a long acting PPI + amoxicillin;(C) Investigate pH-induced activation and trafficking of a urease complex and other proteins to UreI on the inner membrane and determine whether this is regulated by HP0165 or HP0244 The expression of urease by H. pylori (~10% of total protein) is essential for gastric infections. However, at neutral pH, only 1/3rd of urease is active, 2/3rd is present as inactive apoenzyme. pH-dependent activation of the apoenzyme would provide a more rapid response to acid than de novo synthesis. Preliminary results suggest that there is activation and translocation of urease at acidic pH that is dependent on HP0165. UreI serves as the membrane anchor for the pH- dependent relocation of urease to the inner membrane and this is required for activation of apourease. This research may provide new leads for improvement eradication therapy thereby decreasing the risk of peptic ulcer disease and gastric cancer. PUBLIC HEALTH RELEVANCE: Helicobacter pylori is responsible for peptic ulcers and a fortyfold increased risk of gastric cancer. We shall analyze the physiology of H. pylori in the stomach by investigating signaling systems for genes regulated by gastric pH and the role of urease trafficking and activation in infection. A better understanding of effects of acid inhibition on H. pylori may allow improvement or replacement of triple therapy for eradication.